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MRCPUK Endocrinology and Diabetes (Specialty Certificate Examination) Sample Questions:

1. A 55-year-old male-to-female transsexual was reviewed in clinic. She lived as a woman but had not undergone gender reassignment surgery. She was treated with cyproterone acetate 50 mg twice daily and estradiol 2 mg twice daily.
What are the most important tests for monitoring safe replacement?

A) liver function tests and serum prostate-specific antigen
B) lipid profile and liver function tests
C) liver function tests and full blood count
D) lipid profile and serum prostate-specific antigen
E) serum prostate-specific antigen and full blood count

2. A 16-year-old boy was referred with concern about delayed puberty. His stature had been short as a child. He reported an increase in height at the age of 13, and had begun to develop pubic hair at the age of 14. He reported no further growth or development in the past year. His father recalled going through puberty at the age of 13.
On examination, his height was 1.60 m (between 0.4th and 2nd centile), weight was 56.4 kg (between 9th and 25th centile), genital development was Tanner stage 2 and testicular volume was 8 mL bilaterally. Pubic hair was Tanner stage 2, with no evidence of androgenic axillary hair. Bone age at the left wrist was 13.5 years.
Investigations:
serum testosterone2.9 nmol/L (9.0-35.0)
Which feature in his clinical presentation most strongly suggests a diagnosis other than constitutional delay?

A) being below the 2nd centile for height
B) failure to progress through puberty
C) absence of axillary hair in the presence of pubic hair
D) discordance between the height centile and the weight centile
E) 2.5-year delay in bone age

3. A 76-year-old woman with type 2 diabetes mellitus was reviewed. Treatment with thiazolidinedione was being considered, but she was worried about the effect this medication might have on the incidence of complications. She had known background retinopathy.
What complication is more likely to worsen in a patient taking a thiazolidinedione?

A) cataract
B) macular oedema
C) retinal haemorrhages
D) hard exudates
E) retinal vein thrombosis

4. A 35-year-old man presented with newly diagnosed type 2 diabetes mellitus. He had no medical history of note.
When should he inform the UK Driver and Vehicle Licensing Agency (DVLA) of his medical condition?

A) if he starts using basal night-time insulin
B) if he becomes unable to read a car number plate with one eye at 20.5 m
C) if he requires laser treatment to one eye
D) immediately
E) if he starts taking an oral hypoglycaemic agent

5. A 24-year-old woman presented with a 1-year history of secondary amenorrhoea. She also complained of milky discharge from her breasts. She was otherwise well, but had been having difficulty getting pregnant despite regular sexual intercourse. She was taking no medication.
Investigations:
serum prolactin3214 mU/L (<360)
serum thyroid-stimulating hormone2.4 mU/L (0.4-5.0)
serum free T415.6 pmol/L (10.0-22.0)
MR scan of pituitary7-mm left-sided pituitary mass
with no extension beyond the sella
What is the most appropriate licensed therapy in the UK to assist conception?

A) gonadotropin therapy
B) cabergoline
C) bromocriptine
D) clomifene
E) quinagolide

Solutions: